MEDICARE: MARIANNE WIEGMANN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302023142	MI

General Provider Information

NPI Number	:	1093903429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNE WIEGMANN RPH

Provider Business Mailing Address
First Line	:	49477 LEONARD CT
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48044-1815
Country	:	US
Telephone Number	:	586-295-3272
Fax Number	:	586-598-0742

Provider Business Practice Location Address
First Line	:	41601 GARFIELD RD
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-4526
Country	:	US
Telephone Number	:	586-263-0950
Fax Number	:	586-263-9516

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	10/10/2007

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